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Iontophoresis versus subcutaneous injection: a comparison of two methods of local anesthesia delivery in children.

The relative efficacy of local lidocaine anesthesia administered by subcutaneous injection and by iontophoresis was studied in 13 pediatric renal dialysis patients (ages 11-19 years: mean age 15.8 years). Each patient served as his own control at 3 assessment periods. Each type of anesthetic delivery method was administered to either of 2 fistula sites. Patients used visual analogue scales to rate pain, anxiety, and satisfaction for each method. Behavioral observations were made by an observer and a nurse. Paired sample t tests were used to compare the 2 drug delivery methods for patient, observer, and nurse ratings across assessment periods. There were no significant differences between methods for ratings of anxiety before or during the procedure. The injection of lidocaine was rated as more painful by the observer and nurse (with a trend for patients) than the use of iontophoresis. But, the patients and nurse rated the injection method as more effective. Iontophoresis was never rated as superior to the injection method, even after turning over control of drug delivery by iontophoresis to the patient (sessions 2 and 3). Patients were more satisfied with iontophoresis at session 2 when they took over control, but lost enthusiasm by session 3. Three subjects withdrew from the study due to cutaneous burns and prolonged anesthesia delivery time with iontophoresis. Iontophoresis appears to be effective in reducing the pain of dialysis needle insertion but requires further investigation before it can be considered a viable alternative to subcutaneous injection.

Adolescent↗

Induction of squamous metaplasia, dysplasia and carcinoma in situ of the mouse tracheal mucosa by inhalation of sodium chloride mist following subcutaneous injection of 4-nitroquinoline 1-oxide.

Squamous metaplasia, dysplasia and carcinoma in situ (CIS) were induced in the ICR/Jcl mouse tracheal mucosa by exposure to a mist of 5% NaCl solution following single subcutaneous injection of 4-nitroquinoline 1-oxide (4-NQO). Either subcutaneous injection of 4-NQO or NaCl inhalation alone did not cause any marked change in the tracheal mucosa. The NaCl inhalation is considered to have promotion-like action on the mouse tracheal mucosa after administration of 4-NQO injection.

4-Nitroquinoline-1-oxide↗

Epinephrine absorption in adults: intramuscular versus subcutaneous injection.

We report a prospective, randomized, blinded, placebo-controlled, 6-way crossover study of intramuscular versus subcutaneous injection of epinephrine in young men. Peak plasma epinephrine concentrations were significantly higher (P < .01) after epinephrine was injected intramuscularly into the thigh than after epinephrine was injected intramuscularly or subcutaneously into the upper arm. We recommend intramuscular injection of epinephrine into the thigh as the preferred route and site of injection of this life-saving medication in the initial treatment of anaphylaxis.

Absorption↗

Faster and more reliable absorption of adrenaline by aerosol inhalation than by subcutaneous injection.

1. The aim of the present study was to compare absorption of adrenaline given by aerosol spray inhalation with absorption after subcutaneous injection. 2. Arterial plasma adrenaline was measured in nine healthy volunteers following adrenaline administration by both methods. 3. Following inhalation of 20 puffs of adrenaline aerosol, 0.15 mg/puff, a peak arterial adrenaline concentration after 1 min and a rapid fall to baseline from this peak occurred. 4. When given by subcutaneous injection absorption was slower with a peak arterial adrenaline concentration after 4 min. The fall in arterial adrenaline from this peak level was not statistically significant within 30 min after injection. 5. There was less intersubject variation of arterial adrenaline concentration following inhalation when compared with injection. 6. Heart rate, blood pressure and finger tremor followed the changes in arterial adrenaline concentrations. 7. These results indicate that absorption is more reliable when adrenaline is given by inhalation. The rapid fall in arterial adrenaline following inhalation, suggests that repeated inhalations are necessary when such adrenaline therapy is required.

Absorption↗

Differences in acupuncture point SP-10 and non-acupuncture point following subcutaneous injection of Tc-99m pertechnetate.

A new method of radionuclide venography, namely SC-RNV, by subcutaneous injection of Tc-99m pertechnetate at acupuncture points was recently developed in our laboratory. The time-activity curve of SC-RNV can be divided into 3 phases as: the phase of diffusion of radioisotopes through the subcutaneous space, the phase of entrance of radioisotopes into intravascular space to reach a peak concentration and the phase of equilibrium state of radioisotopes in the intravascular space. In this study, we used the 3 phases of SC-RNV to evaluate the absorption of Tc-99m pertechnetate injected subcutaneously in the acupuncture point SP-10 (Xuehai) and in a non-acupuncture point near SP-10. The results revealed that the absorption of Tc-99m pertechnetate via SP-10 was significantly greater than that of non-acupuncture point, evidenced by shorter phase 1, higher peak activity and greater accelerating rate of phase 2. This suggests that the absorption of radioisotopes from acupuncture point is faster and greater than that of non-acupuncture point.

Absorption↗

Tumor induction by a single subcutaneous injection of 1-butyl-1-nitrosourea or 1-butylurea in newborn mice.

A subcutaneous injection of 1-butyl-1-nitrosourea (BNU) at the maximum tolerated dose (333 mg/kg body wt.) to newborn CDF1 mice induced adenocarcinoma and adenoma of the lung, adenoma of the liver, thymic or non-thymic lymphoma and neurinoma of the acusticus nerve; the total incidence of tumors was statistically significant as compared with that of control. However, in the 1-butylurea (BU) mice, one adenoma of the lung was induced in a male mouse; the total incidence of tumor was comparable to that of control.

Adenocarcinoma↗

Recombinant human interleukin 4 (IL-4) given as daily subcutaneous injections--a phase I dose toxicity trial.

Recombinant Interleukin 4 was administered by subcutaneous injection at daily doses of 0.5, 1.0 or 5.0 micrograms kg-1 to nine patients as part of a Phase I Dose Toxicity Study. Dose limiting toxicity was reached at 5 micrograms kg-1 day-1. Symptoms of toxicity included fatigue, 'flu like symptoms and elevated liver enzymes. Modest but significant elevations of neutrophil and platelet counts occurred. No clear evidence of antitumour effects emerged although pain in metastatic lymph nodes and a small fall in myeloma paraprotein levels during dosing were observed. In vitro and murine in vivo studies indicate that patients with lymphoproliferative disease should be selected for Phase II trials.

Bone Marrow↗

Sauna-induced acceleration in insulin absorption from subcutaneous injection site.

The effect of the Finnish sauna on insulin absorption from a subcutaneous injection site was examined in eight insulin-dependent diabetic patients by measuring externally the disappearance rate of 125I-labelled rapid-acting insulin. The sauna (twice for 25 minutes at 85 degrees C) accelerated insulin absorption by 110% as compared with room temperature (p < 0.01). After the sauna blood glucose concentrations were 3.0-3.3 mmol/1 (54.1-59.5 mg/100 ml) lower than on the control day (p < 0.05). The fall in blood glucose values was proportional to the increased rate of insulin absorption (r = 0.30; p < 0.01). The hypoglycaemic effect of a sauna in insulin-treated diabetics is clearly at least partly due to enhanced insulin absorption from the injection site. Such an effect might be prevented by taking a snack or reducing the insulin dose.

Absorption↗

[The interorgan distribution of tritium-labelled para-aminobenzoic acid in the body of rats after its subcutaneous injection].

To study the pharmacokinetics of para-aminobenzoic acid (PABA), rats were subcutaneously injected with 3H-PABA (1 mkg/g body weight) at the stage (P7) when stimulation of outer segments of the photoreceptor cell morphogenesis is possible (Stroeva et al., 1990). The maximum labelling assayed for radioactivity by scintillation counting was observed in the liver 3 h after the injection while, in the blood the labelling was 3 times lower and, in the retina, one order lower than in the liver and blood. The label was detected in all the three types of tissue in 24 and 48 hours, being reduced by an order in comparison with each previous term of measurement. Biological structures binding 3H-PABA were not determined in the present study.

4-Aminobenzoic Acid↗

Long-term study of liver damage following subcutaneous injection of airborne particle extracts and polycyclic aromatic hydrocarbon fractions.

Female NMRI mice aged 9-12 weeks were each given a single subcutaneous injection of 0.5 ml of a suspension containing either the total extracts or the polycyclic aromatic hydrocarbon (PAH) fraction of airborne particles. Both the total extracts and PAH fractions contain 3 microgram benzopyrene. After about 15 months the livers were removed from the animals, which had by that time developed tumors at the injection site, and were subjected to electron-microscopical study. The essential alterations were observed in the nucleoli and the cell nuclei, which had greatly proliferated and exhibited irregular nuclear membranes. Advanced fibrosis was observed in central liver specimens of all groups. Marked alterations were also observed in the mitochondria and the mitochondrial cristae as well as in the bile canaliculi, Intracytoplasmic glycogen usually occurred densely clustered along the periphery of the cell. It may be concluded from the observations that both the total extract of atmospheric suspended particulate matter and the PAH fraction cause hematogenic damage to the liver following subcutaneous injection, a finding which cannot be interpreted as metastatic carcinoma.

Air Pollutants↗

The safe use of epidural anesthesia after subcutaneous injection of low-dose heparin in general abdominal surgery.

OBJECTIVE: To determine if epidural anesthesia after the subcutaneous injection of low-dose unfractionated heparin (LDUH) in patients who undergo elective bowel surgery is safe with respect to hemorrhagic complications. DESIGN: A prospective cohort study. SETTING: Two hospitals affiliated with the Université de Montréal. PATIENTS: Fifty patients scheduled for elective bowel surgery. INTERVENTION: Subcutaneous injection of 5000 units of LDUH and elective surgery for colonic carcinoma, chronic diverticulosis or inflammatory bowel disease. MAIN OUTCOME MEASURES: Activated partial thromboplastin time (APTT), anti-IIa and anti-Xa heparin levels measured before and 2 and 4 hours after injection of LDUH. RESULTS: In no case was the heparin anti-IIa or anti-Xa level higher than 0.20 U/mL, which is considered a significant detectable level of heparin. CONCLUSION: LDUH given subcutaneously is not associated with significant detectable heparin levels, so epidural anesthesia should be safe when performed 2 hours after LDUH injection in patients who undergo general abdominal surgery in the absence of any other impairment of hemostasis.

Anesthesia, Epidural↗

Absorption of subcutaneous injection of Tc-99m pertechnetate via acupuncture points and non-acupuncture points.

SC-RNV, a new method of radionuclide venography by subcutaneous injection of Tc-99m pertechnetate at acupuncture points K-3 (Taixi), was developed in our laboratory. To further investigate whether K-3 is the best point for SC-RNV, Tc-99m pertechnetate was subcutaneously injected at K-3 on one foot and at one of the 11 other acupuncture points (APs) or 3 nonacupuncture points (NAPs) on the opposite foot, simultaneously, in 157 subjects without evidence of venous disorder. The absorption of radioisotopes from each injection site was evaluated by analyzing the time-activity curve at a region of interest set upon over the lower leg above the injection site. The results revealed that the absorption of radioisotopes via K-3 (Taixi) was better than that via NAPs, evidenced by higher peak activity and greater absorption rate. However, there was no significant difference between K-3 injection and other APs injections except Liv-2 and Liv-3. These results indicate that absorption of radioisotopes via APs is better than via NAPs. This together with the fact that K-3 is easier to detect than other APs in feet, suggests that K-3 is a good point for SC-RNV.

Absorption↗

A comparison of epidural catheters with or without subcutaneous injection ports for treatment of cancer pain.

The aim of this study was to compare the incidence of technical complications of epidural catheters with subcutaneous injection ports to percutaneous epidural catheters without ports, fixed only by adhesive dressing. We reviewed 149 patients who received 250 epidural catheters for treatment of cancer pain during a 3 1/2-yr period from January 1, 1989, to June 30, 1992. Of the 250 catheters, 52 were provided with subcutaneous injection ports and 198 were percutaneous catheters. Of the 198 percutaneous catheters, 41 were tunneled for a short distance; the remainder entered the skin at the dorsal midline. In the percutaneous group 21% of the catheters became dislodged. In the injection port group, there were no catheter dislodgements. The overall incidence of infections was similar in both groups (13.6%). When we indexed the infection rate to catheter-days, the number of infections per 1000 catheter-days in the injection port group was half that of the percutaneous group (2.86 infections versus 5.97 for percutaneous catheters). No injection port became infected during the first 70 days of treatment, whereas in the percutaneous group infections occurred as early as the first week. Within the percutaneous group the complication rate in the tunneled epidural catheters was as high as in the nontunneled. We conclude that injection ports reduce the complication rate of epidural catheters, particularly catheter dislodgement and early infections.

Adult↗

Free radical-mediated lung response to the monofunctional sulfur mustard butyl 2-chloroethyl sulfide after subcutaneous injection.

Vesicant-induced pathogenesis is initiated by rapid alkylation and cross-linking of DNA purine bases causing strand breaks leading subsequently to NAD depletion and cell death. We postulated that vesicants may also be associated with free radical-mediated oxidative stress distal to the site of exposure. To test this postulate in the lung, we injected 3 groups (n = 8) of 5-month-old, male, athymic, nude mice, weighing 30-35 g with a single subcutaneous (s.c.) injection (5 microliters/mouse) of butyl 2-chloroethyl sulfide (BCS), a monofunctional sulfur mustard analog. After 1, 24 and 48 h, we euthanized the treated mice along with 2 untreated control mice at each time point. We then pooled the control mice in one group (n = 6) and analyzed the lungs for biochemical indices of oxidative stress. We found that total lung weight was not altered after treatment, but wet/dry weight ratio decreased 18% (P less than 0.05) and hemoglobin content increased 50% and 36% at 1 and 24 h, respectively. The activity of glucose-6-phosphate dehydrogenase increased significantly, 40% at 1 and 24 h and 84% at 48 h and that of glutathione S-transferases was 60%, P less than 0.05 greater at all time points. Lipid peroxidation (estimated by the thiobarbituric acid test) and total protein content increased 3-fold and 2-fold, at 1 and 24 h, respectively. Total and oxidized glutathione contents were significantly elevated, 38% at 1 h and 64% at 24 h for the former and 45% at 24 h and 56% at 48 h for the latter. Because these changes are consistent with the cellular response to oxidative stress, we conclude that BCS injected subcutaneously, can cause changes in the lung possibly via a free radical-mediated mechanism.

Animals↗

Depletion of intramuscularly and subcutaneously injected procaine penicillin G from tissues and plasma of yearling beef steers.

Withdrawal periods required when doses of 24,000 IU and 66,000 IU of procaine penicillin G/kg body weight were administered to yearling beef steers by intramuscular injection daily for five consecutive days were investigated. These dosages are in excess of product label recommendations, but are in the range of procaine penicillin G dosages that have been administered for the treatment of some feedlot bacterial diseases. The approved dose in Canada is 7,500 IU/kg body weight intramuscularly, once daily, with a withdrawal period of five days. Based on the tissue residue data from this study, the appropriate withdrawal period is ten days for the 24,000 IU/kg body weight dose and 21 days for the 66,000 IU/kg body weight dose when administered intramuscularly to yearling beef steers. In a related study, 18 yearling beef steers received 66,000 IU of procaine penicillin G/kg body weight administered by subcutaneous injection, an extra-label treatment in terms of both dose and route of administration, typical of current practice in some circumstances. Deposits of the drug were visible at subcutaneous injection sites up to ten days after injection, with more inflammation and hemorrhage observed than for intramuscular injections of the same dose. These results suggest that procaine penicillin G should not be administered subcutaneously at high doses; and therefore a withdrawal period was not established for subcutaneous injection.

Animals↗

Toluene blood level following subcutaneous injection of toluene in the rat.

A model of toluene level in blood following subcutaneous injection of toluene mixed with polyoxyethylated-vegetable-oil vehicle was developed. The purpose was to provide a means of predicting dose received for subsequent toxicologic studies for any time and dose combination. The pharmacokinetics were of secondary interest. Using data from 111 rats, a four-parameter equation was devised to predict the time course of toluene blood level from 20-480 min post dosing, for dose levels of 50-1000 mg/kg. Blood concentrations rose at a rate which was independent of dose level. Maximum blood levels were uniquely determined by dose level. Blood levels fell at different rates depending upon dose level. Injection exposure, when compared to inhalation, has the advantages of (a) low expense, (b) low equipment requirements, and (c) simplicity. The disadvantage is, for some experiments, poor temporal stimulation of the normal route of administration, inhalation.

Animals↗

Inhalation of insulin in dogs: assessment of insulin levels and comparison to subcutaneous injection.

Pulmonary insulin delivery is being developed as a more acceptable alternative to conventional subcutaneous administration. In 15 healthy Beagle dogs (average weight 9.3 kg), we compared insulin distribution in arterial, deep venous, and hepatic portal circulation. Dogs received 0.36 units/kg s.c. regular human insulin (n = 6) or 1 mg (2.8 units/kg) or 2 mg (5.6 units/kg) dry-powder human inhaled insulin (n = 3 and 6, respectively). Postinhalation of inhaled insulin (1 or 2 mg), arterial insulin levels quickly rose to a maximum of 55 +/- 6 or 92 +/- 9 microU/ml, respectively, declining to typical fasting levels by 3 h. Portal levels were lower than arterial levels at both doses, while deep venous levels were intermediate to arterial and portal levels. In contrast, subcutaneous insulin was associated with a delayed and lower peak arterial concentration (55 +/- 8 microU/ml at 64 min), requiring 6 h to return to baseline. Peak portal levels for subcutaneous insulin were comparable to those for 1 mg and significantly less than those for 2 mg inhaled insulin, although portal area under the curve (AUC) was comparable for the subcutaneous and 2-mg groups. The highest insulin levels with subcutaneous administration were seen in the deep venous circulation. Interestingly, the amount of glucose required for maintaining euglycemia was highest with 2 mg inhaled insulin. We conclude that plasma insulin AUC for the arterial insulin level (muscle) and hepatic sinusoidal insulin level (liver) is comparable for 2 mg inhaled insulin and 0.36 units/kg subcutaneous insulin. In addition, arterial peak concentration following insulin inhalation is two times greater than subcutaneous injection; however, the insulin is present in the circulation for half the time.

Administration, Inhalation↗

Subcutaneous injection of elemental mercury with distant skin lesions.

BACKGROUND: Mercury poisoning presents a variety of clinical pictures depending on chemical structure, amount absorbed, total mercury burden, and individual factors. Distant skin lesions, after subcutaneous injection of metallic mercury, have not been previously described. CASE REPORT: We present a homicidal, subcutaneous injection of mercury resulting in widespread skin lesions, remote from the radiologically visible mercury. The lesions appeared at 40 days and began to clear at 6 months after the injection.

Adult↗